Clinical Outcomes of Percutaneous Endoscopic Interlaminar Discectomy Using a Laminotomy Technique With Modified Stepwise Local Anesthesia

BACKGROUND: Percutaneous endoscopic interlaminar discectomy (PEID) has been widely used in minimally invasive treatment of lumbar disc herniation (LDH) but is difficult to perform because of the narrow interlaminar window and painful for the patient. Therefore, further research is needed to find a safe and effective method to facilitate the development of PEID.METHODS: Seventy-one consecutive patients with LDH who underwent PEID using a laminotomy technique with modified stepwise local anesthesia between July 2017 and June 2020. All patients were followed up for at least 6 months. Preoperative patient demographics, perioperative outcomes, and clinical outcomes were recorded. Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) scores, and Macnab criteria were used to assess clinical results.RESULTS: All patients underwent successful surgery u nder local anesthesia with no conversions to open surgery. The mean operation time was 79.56 +/- 32.78 min utes and the average hospital stay was 6.44 +/- 2.98 n ights. Before surgery, the mean VAS score was 5.66 +/- 1.206 and the mean ODI score was 68.41 +/- 6.634; the respective scores were decreased to 0.65 +/- 0.635 and 7.06 +/- 1.594 after 4 weeks of follow-up (P < 0.001) and to 0.56 +/- 0.691 and 7.11 +/- 0.176 after 6 months (P < 0.001). According to the MacNab criteria, the outcome was excellent in 60 cases and good in the remaining 11 cases.CONCLUSIONS: PEID via a laminotomy technique with stepwise local anesthesia is safe and effective for L4-5 and L5-S1 LDH.